Congressman Glenn Grothman Attends WHA Roundtable Discussion

Opioid Treatment, 340B, and OPPS rule on site-neutral payments all highlighted

August 28, 2018

U.S. Congressman Glenn Grothman joined area health system and hospital leaders from his district at a WHA roundtable discussion hosted at Ascension NE Wisconsin – Mercy Campus in Oshkosh. The meeting covered a wide range of current important federal topics including mental health and opioid treatment, federal regulatory reform proposals such as the Stark Law, recent developments in the 340B program, and concerns with CMS’ proposed cuts to offsite hospital outpatient departments (site-neutral payments) in the 2019 Outpatient Prospective Payment System (OPPS) rule.
Ascension Mercy’s Chief Administrative Officer Denise Parrish kicked off the discussion by talking about what they are doing in their community to meet growing mental health and substance use treatment needs. She highlighted Mercy’s recently completed eight-bed inpatient geriatric psychiatric unit, which Congressman Grothman toured while it was under construction in May, and how it is helping to meet the needs of the area’s aging population. Other members also talked about efforts to assist with suicide prevention in the Fox Valley and how some area emergency departments are adding recovery coaches to assist patients after an overdose. The group thanked Grothman for his recent votes to pass legislation aligning 42 CFR with HIPAA, which would make it easier to share mental health and substance abuse records, as well as allow Medicaid to fund treatment at institutions of mental disease and behavioral health facilities that have more than 16 beds.

The group praised CMS and Congress for ongoing efforts to reduce the regulatory burden on hospitals. Congressman Grothman lamented about how much paperwork the federal government has piled on health care providers over the years in the name of oversight, and said he was interested to see what positive reforms may come from the Ways and Means Committee’s recent Medicare Red Tape Relief Report. The group also discussed ways the physician self-referral law, known as the Stark Law, deters hospitals and health systems from embracing value-based payment reforms due to potential penalties. The group also provided information about the amount of time and resources hospitals must devote to reviewing physician contracts to ensure they are in compliance with the law.
The discussion ended with members voicing concern over a new proposal from CMS in the 2019 OPPS rule that would reduce payments for offsite hospital outpatient clinic visits. While CMS has framed these cuts as site-neutral payments that will save Medicare $760 million in 2019, WHA members reminded Congressman Grothman that Congress had specifically grandfathered these hospital-based outpatient clinics on two separate occasions, and that these cuts go against Congressional intent. They also reminded him that these higher outpatient payments were designed to offset other under-reimbursed costs hospitals have that physician clinics do not, such as inspections, 24/7 emergency department staffing, and a federal requirement that they must serve anyone who walks into their emergency room, regardless of their ability to pay. Congressman Grothman asked the group to keep him updated on ways he might be able to assist.

This story originally appeared in the August 28, 2018 edition of WHA Newsletter